Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report prese... more Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report presents a case of ventricular noncompaction diagnosed late in endstage cardiac failure and malignant ventricular arrhythmia, which required an Abiomed biventricular assist device as a bridge to transplantation.
Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report prese... more Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report presents a case of ventricular noncompaction diagnosed late in endstage cardiac failure and malignant ventricular arrhythmia, which required an Abiomed biventricular assist device as a bridge to transplantation.
The Journal of Thoracic and Cardiovascular Surgery, 2006
Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remain... more Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population. The hybrid stage I procedure was performed in the catheterization laboratory. Via a median sternotomy, both branch pulmonary arteries were banded, and a ductal stent was delivered via a main pulmonary artery puncture and positioned under fluoroscopic guidance. Between October 2003 and June 2005, 14 high-risk neonates underwent a hybrid stage I procedure. Eleven of 14 had hypoplastic left heart syndrome. Two also underwent peratrial atrial septal stenting, and 5 required percutaneous atrial stenting later. Two neonates with an intact or highly restrictive atrial septum had emergency percutaneous atrial stent placement. Hospital survival was 11 (78.5%) of 14. One patient required extracorporeal membrane oxygenation support for intraoperative cardiac arrest. He underwent cardiac transplantation but died later of sepsis. One patient died of ductal stent embolization, and a third died of progressive cardiac dysfunction. The first 4 patients required pulmonary artery band revisions. There were none after we modified our technique and added branch pulmonary artery angiograms. There were 2 interstage deaths from atrial stent occlusion and from preductal retrograde coarctation. Eight patients underwent stage II procedures, consisting of aortic arch reconstruction, atrial septectomy, and cavopulmonary shunt. Two patients died after stage II. One patient is awaiting stage II. The hybrid stage I palliation is a valid option in high-risk neonates. As experience is accrued, it may become the preferred alternative. However, in aortic atresia, the development of preductal retrograde coarctation is a significant problem.
Herein, a policy of primary surgical closure of large ventricular septal defects in infants is re... more Herein, a policy of primary surgical closure of large ventricular septal defects in infants is reviewed. Fortyeight infants met criteria for inclusion in the study, and were divided into two groups based on weight: group 1 infants weighed 4 kg or less (n = 23), and group 2 infants weighed more than 4 kg (n = 25). Both groups had similar variation in ventricular septal defect location (paramembranous versus muscular) and number (single versus multiple), as well as incidence of major associated extracardiac diseases. No early deaths occurred in group 1, compared with 1 infant (4%) in group 2. Major complications occurred similarly in both groups (9% versus nfants with large ventricular septal defects (VSDs) and I intractable congestive heart failure (CHF), growth retardation, and, less often, elevated pulmonary vascular resistance (PVR) constitute a substantial percentage of patient referrals to pediatric cardiothoracic surgeons. Although the majority tolerate primary surgical VSD closure with low morbidity and mortality, experience with younger and smaller infants has been variably less satisfactory. Most case series of infants undergoing primary VSD repair have reported perioperative mortality rates between 2% and 17%; however, mortality rates for infants less than 4 months of age or less than 4 kg in weight were much higher, between 9% and 75% [1-8]. Consequently, some authors have advocated protracted medical support until the infant with a large VSD is older and larger [3,5], or pulmonary artery (PA) banding for very small infants [8, 91 or those with multiple muscular VSDs [7, 8, 10, 111 who require urgent surgical intervention.
Little is known about the safety of pediatric cardiac surgery in children with end-stage liver di... more Little is known about the safety of pediatric cardiac surgery in children with end-stage liver disease. We reviewed our experience with 4 patients with biliary atresia or Alagille's syndrome who underwent repair of ventricular septal defect and tricuspid regurgitation, atrioventricular canal, subaortic stenosis, or supravalvular aortic stenosis. One patient died on postoperative day 2. All other patients survived to discharge. At follow-up, 1 patient died at home awaiting liver transplantation and the remaining patients are doing well. One patient received a successful liver transplant. Pediatric cardiac surgery in children with end-stage liver disease can be done safely, albeit with a higher mortality.
Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, ofte... more Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, often presenting with hepatitis, meningo-encephalitis, disseminated intravascular coagulation (DIC), and myocarditis. Neonatal myocarditis often proves fatal. We report here a case of neonatal enteroviral myocarditis with multisystem organ failure and ischemic cardiomyopathy that was managed medically.
Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report prese... more Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report presents a case of ventricular noncompaction diagnosed late in endstage cardiac failure and malignant ventricular arrhythmia, which required an Abiomed biventricular assist device as a bridge to transplantation.
Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report prese... more Ventricular noncompaction is a rare but welldocumented cause of cardiomyopathy. This report presents a case of ventricular noncompaction diagnosed late in endstage cardiac failure and malignant ventricular arrhythmia, which required an Abiomed biventricular assist device as a bridge to transplantation.
The Journal of Thoracic and Cardiovascular Surgery, 2006
Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remain... more Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population. The hybrid stage I procedure was performed in the catheterization laboratory. Via a median sternotomy, both branch pulmonary arteries were banded, and a ductal stent was delivered via a main pulmonary artery puncture and positioned under fluoroscopic guidance. Between October 2003 and June 2005, 14 high-risk neonates underwent a hybrid stage I procedure. Eleven of 14 had hypoplastic left heart syndrome. Two also underwent peratrial atrial septal stenting, and 5 required percutaneous atrial stenting later. Two neonates with an intact or highly restrictive atrial septum had emergency percutaneous atrial stent placement. Hospital survival was 11 (78.5%) of 14. One patient required extracorporeal membrane oxygenation support for intraoperative cardiac arrest. He underwent cardiac transplantation but died later of sepsis. One patient died of ductal stent embolization, and a third died of progressive cardiac dysfunction. The first 4 patients required pulmonary artery band revisions. There were none after we modified our technique and added branch pulmonary artery angiograms. There were 2 interstage deaths from atrial stent occlusion and from preductal retrograde coarctation. Eight patients underwent stage II procedures, consisting of aortic arch reconstruction, atrial septectomy, and cavopulmonary shunt. Two patients died after stage II. One patient is awaiting stage II. The hybrid stage I palliation is a valid option in high-risk neonates. As experience is accrued, it may become the preferred alternative. However, in aortic atresia, the development of preductal retrograde coarctation is a significant problem.
Herein, a policy of primary surgical closure of large ventricular septal defects in infants is re... more Herein, a policy of primary surgical closure of large ventricular septal defects in infants is reviewed. Fortyeight infants met criteria for inclusion in the study, and were divided into two groups based on weight: group 1 infants weighed 4 kg or less (n = 23), and group 2 infants weighed more than 4 kg (n = 25). Both groups had similar variation in ventricular septal defect location (paramembranous versus muscular) and number (single versus multiple), as well as incidence of major associated extracardiac diseases. No early deaths occurred in group 1, compared with 1 infant (4%) in group 2. Major complications occurred similarly in both groups (9% versus nfants with large ventricular septal defects (VSDs) and I intractable congestive heart failure (CHF), growth retardation, and, less often, elevated pulmonary vascular resistance (PVR) constitute a substantial percentage of patient referrals to pediatric cardiothoracic surgeons. Although the majority tolerate primary surgical VSD closure with low morbidity and mortality, experience with younger and smaller infants has been variably less satisfactory. Most case series of infants undergoing primary VSD repair have reported perioperative mortality rates between 2% and 17%; however, mortality rates for infants less than 4 months of age or less than 4 kg in weight were much higher, between 9% and 75% [1-8]. Consequently, some authors have advocated protracted medical support until the infant with a large VSD is older and larger [3,5], or pulmonary artery (PA) banding for very small infants [8, 91 or those with multiple muscular VSDs [7, 8, 10, 111 who require urgent surgical intervention.
Little is known about the safety of pediatric cardiac surgery in children with end-stage liver di... more Little is known about the safety of pediatric cardiac surgery in children with end-stage liver disease. We reviewed our experience with 4 patients with biliary atresia or Alagille's syndrome who underwent repair of ventricular septal defect and tricuspid regurgitation, atrioventricular canal, subaortic stenosis, or supravalvular aortic stenosis. One patient died on postoperative day 2. All other patients survived to discharge. At follow-up, 1 patient died at home awaiting liver transplantation and the remaining patients are doing well. One patient received a successful liver transplant. Pediatric cardiac surgery in children with end-stage liver disease can be done safely, albeit with a higher mortality.
Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, ofte... more Neonatal entero-viral sepsis is a rare but fulminant infection with multisystem involvement, often presenting with hepatitis, meningo-encephalitis, disseminated intravascular coagulation (DIC), and myocarditis. Neonatal myocarditis often proves fatal. We report here a case of neonatal enteroviral myocarditis with multisystem organ failure and ischemic cardiomyopathy that was managed medically.
Uploads
Papers by Joel Hardin